儿童手掌侧瘢痕切除后采用足底全厚皮植皮的临床效果观察  

Observation on the clinical effect of using full thickness plantar skin grafting after scar excision on the palmar side of children's hands

作　　者：周一冲 林丽 戴叶锋[1] 刘雨欣 赵雄[1] 岳晓洁[1] Zhou Yichong;Lin Li;Dai Yefeng;Liu Yuxin;Zhao Xiong;Yue Xiaojie(Department of Burn and Plastic Surgery,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院烧伤整形外科、国家儿童健康与疾病临床医学研究中心,杭州310052

出　　处：《中华手外科杂志》2024年第3期215-220,共6页Chinese Journal of Hand Surgery

基　　金：浙江省基础公益研究计划(LGF20H150005)。

摘　　要：目的观察采用足底全厚皮片移植治疗儿童手掌侧瘢痕挛缩畸形的临床效果.方法自2021年1月至2022年12月我科收治63例儿童手掌侧瘢痕挛缩畸形患儿,男34例,女29例;年龄11个月至7岁4个月,手术松解切除挛缩瘢痕组织后均采用全厚皮片移植覆盖,根据全厚皮片的供区分为足底内侧区(36例)和腹股沟区两组(27例).术后采用总主动活动度(TAM)评价两组患儿手部功能恢复情况;采用温哥华瘢痕评定量表(VSS)分别对两组患儿的植皮受区和供区的外观、色泽、血管分布及柔软度进行评价;评估手术效果的家长满意度.结果63例患儿术后随访6~18个月,TAM评价手部功能恢复情况,两组间比较差异无统计学意义(Z=0.128,P>0.05).采用VSS量表评价植皮受区和供区瘢痕,植皮受区的色泽评分,足底内侧区组低于腹股沟区组,差异有统计学意义(Z=6.589,P<0.001);受区和供区的瘢痕厚度比较,足底内侧区组评分均低于腹股沟区组,差异有统计学意义(Z=2.653,P<0.01;Z=4.942,P<0.001);其他分项评分,差异无统计学意义(P>0.05).植皮受区手术效果的家长满意度比较,足底内侧组评价为优者的比例高于腹股沟区组,差异有统计学意义(Z=2.430,P<0.05).结论采用足底全厚皮片移植治疗儿童手掌侧瘢痕挛缩畸形,功能恢复良好,特别是对于外观的改善较为明显,临床效果确切.Objective To observe the clinical efficacy of using full-thickness plantar skin grafting to treat pediatric palmar scar contracture deformity.Methods From January 2021 to December 2022,63 children with palmar scar contracture deformity were treated,including 34 males and 29 females.The age was ranged from 11 months to 7 years and 4 months.After surgical release and excision of contracted scar tissue,full thickness skin grafts were used for coverage.According to the supply of full thickness skin grafts,they were divided into two groups:the medial plantar area(36 cases)and the inguinal area(27 cases).The total active range of motion(TAM)was used to evaluate the recovery of hand function in two groups of patients after surgery.The Vancouver Scar Assessment Scale(VSS)was used to evaluate the appearance,color,vascular distribution,and softness of the skin graft recipient and donor areas in two groups of children.The parental satisfaction with surgical outcomes was assessed.Results All 63 patients were follow-up for 6 to 18 months after surgery,and TAM was used to evaluate the recovery of hand function.There was no statistically significant difference between the two groups(Z=0.128,P>0.05).The VSS scale was used to evaluate the scar tissue in the graft recipient area and donor area.The color score of the graft recipient area was lower in the medial plantar area group than in the inguinal area group,and the difference was statistically significant(Z=6.589,P<0.001).The comparison of scar thickness between the recipient and donor areas showed that the scores in the medial plantar area group were lower than those in the inguinal area group,with statistical significance(Z=2.653,P<0.01;Z=4.942,P<0.001).There was no statistically significant difference in the scores of other sub items(P>0.05).The comparison of parental satisfaction with the effectiveness of skin grafting surgery showed that the proportion of those who rated as excellent was higher in the medial plantar area group than in the inguinal area group,and the differ

关 键 词：儿童 治疗结果 手掌挛缩性瘢痕 植皮 全厚皮片 

分 类 号：R726.5[医药卫生—儿科]